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The performance of syphilitic scleritis

Updated: Saturday, Feb 20,2010, 12:28:29 PM
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Common serious ocular lesions and stromal keratitis, uveitis, chorioretinitis, optic neuritis, inflammation around the optic nerve, optic nerve retinitis, optic atrophy, ptosis, strabismus, eyelid margin or limbus chancre, orbital periostitis , Argyll-Roberston pupil and sclera, or outer layer of scleritis inflammation.

It is reported that scleritis patients with syphilis incidence 2.89%, scleritis can be the initial manifestations of syphilis. Second, tertiary syphilis or congenital syphilis will occur scleritis, scleral inflammation can occur in the outer one syphilis. Syphilitic scleritis or scleral outer layer of the occurrence of inflammation by Treponema pallidum in direct violation of (1 or 2) or by Treponema pallidum and its metabolites caused by the immune response (3 or congenital).

Acquired syphilis is divided into three:

1, syphilis: the outer sclera conjunctival inflammation secondary to chancre, ears before and submandibular lymphadenitis.

2, Syphilis: scleritis or scleral inflammation and the outer layer of the skin, mucous membrane damage occur at the same time or subsequently appeared more associated with conjunctival lesions. Scleritis or scleral and conjunctival inflammation outer boundaries of significant lesions, corneal margin of edema, folds.

3, syphilis: scleritis or scleral outer layer similar to inflammation and other diseases. The period of scleritis can be diffuse, nodular and necrotizing anterior scleritis and posterior scleritis. Immune mechanisms leading to the sclera infectious granulomatous and infectious microangiopathy. Scleritis may be associated with stromal keratitis. Syphilitic stromal keratitis, unilateral, in the early stages may have eye pain, tearing, photophobia, and decreased vision. Lesions confined to the upper portion of the cornea, mild endothelial edema, showing a small muddy substrate. 5 months after infection to 10 years, the disease spread from the periphery to the central, deep corneal opacity occurred, and convergence, affecting partial or the entire cornea. Corneal thickening lesions, Descemet's layer fold, resulting in broken lens-like phenomenon, the last vessel of deep stromal invasion reached to form a dark red brush-like deep corneal neovascularization. Inflammation for several weeks and several months later, corneal infiltration and edema gradually absorbed, the inflammation subsided, the blood vessels invade the cornea blood flow disappeared, shrinking the deep corneal neovascularization in the cornea leaving Mirage tiny blood vessels within the grass-roots network, manifested as off-white fine filamentary structure. Even anterior uveitis may occur. The period of the outer sclera inflammation of simple or nodular. Eye accompanied by the performance of other systems occurs, such as nerve damage or cardiovascular disease, syphilis.

In children with congenital syphilis, scleritis in the characteristic symptoms appear years after the occurrence of less serious, long-course treatment of poor results. Scleritis type of diffuse anterior scleritis or posterior scleritis. 5% ~ 20% of scleritis patients with concurrent stromal keratitis, eyes, easy to relapse, compared with three more serious stromal keratitis of syphilis can be spread more associated with anterior uveitis. Various types of clinical manifestations of scleritis mainly in the following categories:

1. Sclera outer layer of the sudden onset inflammation, red eye, eye pain, pain at night obviously. Generally does not affect vision. Simple inflammation of the outer surface of the sclera sclera and the top of the bulbar conjunctiva diffuse congestion and edema, color red. 2 / 3 cases of limitations, 1 / 3 cases of a wide range. Scleral expansion of surface blood vessels and tortuous, and radial. Visibility reflex eyelid edema. Nodular scleral edge of the outer surface of the sclera inflammation sclera infiltration of edema, to form the surface of the sclera limitations of mobile fire red nodules, single or multiple, ranging from several millimeters in diameter, marked tenderness. Syphilitic scleritis can be spread to the sclera wall before the rear to form a diffuse, nodular and necrotizing anterior scleritis and posterior scleritis. Subjective symptoms are red eyes, eye pain, photophobia, tearing, conjunctival sac secretions, and decreased vision. Eye pain, particularly at night or at night, along the trigeminal nerve branches of radiation. The most serious of necrotizing anterior scleritis. Eye pain intensity is proportional to the degree of inflammation. Posterior scleritis limitations, we can not hand the performance of the Department of congestion. Posterior scleritis alone occurs, vision loss and sometimes the only performance. Depending on the extent of vision loss ocular complications may be.

2. Diffuse anterior scleritis syphilitic scleritis about 40%, which is a variety of scleritis of the most benign kind. Ocular conjunctiva and anterior scleral hyperemia and swelling. Severe cases a high degree of bulbar conjunctiva edema, need to drop 1:1000 adrenaline in order to determine whether scleral edema, or nodules. Lesions confined or occupy the whole of the former sclera.

3. Nodular anterior scleritis or about 44% of syphilitic scleritis. Single or multiple nodules, showing deep red, is located deep scleral local, totally could hardly move. The majority of patients refuse pain and nodules according to the surface of blood vessels for the nodules from the top.

4. Necrotizing anterior scleritis syphilitic scleritis about 9.6%, this type of the most destructive, more than 60% of patients have this complication, many of syphilis occurred in the second and third phases. Is first expressed as the limitations of sheet scleritis, and has acute congestive. If found flaky avascular scleral surface area, which may have necrotizing anterior scleritis. Without timely treatment, the district organization can complete necrosis of the sclera, sclera inflammation from the original lesion at the both sides of the surrounding development, the final damage and the whole front of the sclera. Because scleral necrosis, scleral thinning, uveal exposed to form a staphyloma. Necrotizing anterior scleritis can be two, three independent emergence of syphilis may also be due to diffuse or nodular anterior scleritis without the formation of the development of timely treatment.

5. After the syphilitic scleritis scleritis about 6.4%. Mostly occurs in tertiary syphilis or congenital syphilis. Anterior and posterior scleritis exist accounted for 1 / 2 or more. Eyes more common, namely, eyes newly diagnosed posterior scleritis accounted for 33%. Signs of syphilitic posterior scleritis include: a result of inflammation spread to the extraocular muscles and eyelid organizations, there is limited eye movement, diplopia, ptosis, and eyelid edema. When the retina choroid involving the performance of a variety, showing non-specific changes: ① subretinal mass: syphilitic scleritis occurring after the rate of 14%, with a dome-shaped mass with normal retinal pigment epithelium also radiate orange; mass Office choroid appearance of a checkerboard grid; mass around the choroidal folds and retinal stripes surrounding three important features. ② choroidal folds, retinal stripes: syphilitic scleritis after the rates were 14%, 16.3%, two can exist alone, but also simultaneously. Performance that is localized to the posterior pole-like changes in light and dark and white lines, temporal side more common, and often the level of surrounding subretinal mass in the surroundings. ③ optic disc edema, cystoid macular edema: the incidence of syphilitic posterior scleritis rates for 2.3%. After the sclera and choroid by inflammation spread to the optic nerve and retina. ④ annular choroidal detachment and exudative retinal detachment: the two syphilitic scleritis after the occurrence rates were 17.5%, 34.8%, posterior scleritis and choroidal invasion occurred annular choroidal detachment. Can also be caused by posterior pole of blood - retinal barrier breakdown, there exudative retinal detachment. Others include a rare peripheral retinal detachment. Wilhelmus, etc. before and after the scleritis found to suffer from those, about half of those in anterior uveitis. Are authors report different proportions of patients with posterior scleritis found in vitreous cells or intraocular pressure and so on.

The diagnosis of syphilis based mainly on history, clinical manifestations, laboratory analysis, etc. to judge.

Syphilitic scleritis syphilis infection based mainly on history and clinical manifestations of ocular more able to confirm the diagnosis, reference checks and laboratory examinations systemic positive findings, it could further determine the etiological diagnosis. However, the diagnosis of syphilitic posterior scleritis posterior scleritis due to the signs and symptoms are diverse, complex performance in severity, rarely found in the sclera spirochetes, in particular the three and congenital syphilis, diagnosis is more difficult. According to medical history and symptoms, in particular, have fundus changes, supplemented by B ultrasonography and CT, MRI scans can make a correct diagnosis.

Congenital syphilitic scleritis may be the child's history of ocular inflammation, history of past treatment of syphilis, the mother's history of positive syphilis serology, other eye symptoms, such as salt and pepper-like chorioretinitis of the fundus changes, or eyeball atrophy, or late syphilis of the clinical manifestations, such as deafness, dental abnormalities, arch-shaped saddle-like nose and palate, or FTA-ABS or MHA-TP test was positive and diagnosis.

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